Here are 10 of the biggest global health issues that health workers are watching in 2013.1) The growing role of frontline health workers
“Frontline health worker” is a relatively new term that made the news this year. It includes not only midwives andcommunity health workers but also pharmacists, nurses, and doctors who serve in local clinics as the first (and often only) source of care for millions of people in remote areas. Frontline health workers can expect to remain in the spotlight in 2013.
In January 2012, IntraHealth International and our partners founded the Frontline Health Workers Coalition to urge greater and more strategic U.S. investment in frontline health workers in developing countries. Its campaign efforts helped lead Representative Nita Lowey of the U.S. Congress to introduce a resolution asking U.S. agencies to coordinate their efforts to support frontline health workers in developing countries. Though the resolution was not enacted in 2012, we expect to see continued political attention on frontline health workers and hope to see a similar pledge in in 2013.
2) The need for more community health workers
There’s a shortage of over 4 million skilled, motivated health workers worldwide. Several health workforce campaigns launched in 2012—including the U.S. Agency for International Development’s Global Health Evidence Summit—called for more people to become health workers and for better support for them. The campaigns are calling for at least a million new community health workers.
Many countries are now implementing large-scale programs to train more community health workers and extend the reach of their services to underserved populations. Thanks to this particular workforce, Ethiopia, India, Rwanda, and several other countries have made great progress in maternal and child survival.
3) The rebirth of family planning
Family planning got a much-needed boost this year, starting in July with the London Summit on Family Planning. Governments, nongovernmental organizations, and other civil society groups came together to pledge their efforts—and an additional $2.6 billion—to make voluntary contraception more widely accessible by 2020.
If all women and couples worldwide could use the contraceptive methods they want and need, unintended pregnancies would decline from 80 million to 26 million. There would be 26 million fewer abortions. And pregnancy-related deaths would drop by 79,000.
It takes skilled health workers to administer most modern methods of contraception. More workers will need training to offer high-quality services while also respecting confidentiality and providing friendly, nonjudgmental counsel. Read the new 2012 report issued by the Guttmacher Institute and UNFPA, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012, to learn more.
4) Helping even more children to live longer
According to UNICEF’s 2012 progress report, Committing to Child Survival: A Promise Renewed, many countries have dramatically reduced their numbers of child deaths. Worldwide, child mortality has dropped from nearly 12 million under-five deaths in 1990 to 6.9 million in 2011.
In June 2012, over 80 country representatives gathered at the Child Survival Call to Action and challenged the world to reduce child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035—that would be 45 million children saved.
To make this happen, the health sector needs better and more systematic data collection. And health workers will have to use more high-impact interventions to tackle the major causes of newborn and child mortality. These include family planning for optimal birth spacing, as well as nutrition and services that address the top causes of childhood death.
5) AIDS: getting to zero
HIV is the world’s leading infectious killer. One of the greatest obstacles we face in fighting and treating HIV, according to the World Health Organization’s Global Health Workforce Alliance, is the global shortage of health workers.
HIV/AIDS prevention, treatment, and care depend on health workers who have the right skills and are in the right places. More existing health workers will be called on and trained to address these needs. Countries looking to improve their response to the epidemic will work to expand their health workforces and to retain their skilled staff.
6) The continuing fight against malaria
Malaria cases and deaths around the world are down, according to the World Malaria Report 2012. But progress was slower this past year than in previous years. In order to win the fight against malaria, health workers will have to focus on prevention, quick diagnoses, and prompt, effective treatment.
As we reported last year, health workers can use rapid diagnostic tests to quickly rule out other illnesses that may also cause malaria-like symptoms, and to prevent over-use of antimalarial medications—this is crucial for children under five. More health workers will be learning how to manage malaria cases and manage supply chains to ensure that high-quality drugs are consistently available in the health workers’ clinics, health huts, and other points of care.
7) Eradicating polio
While polio incidence has dropped more than 99% since 1988, there were still 214 cases reported in 2012, most in Afghanistan, Nigeria, and Pakistan. Polio is a crippling and potentially fatal infectious disease. It has no cure. That’s why vaccinations—and trained health workers to administer them—are essential.
Last month, several health workers immunizing children in Pakistan were attacked and killed, causing UNICEF to suspend its program in that country. While health workers in 2013 will continue to provide vaccinations against polio and other illnesses, health workers will also contend with the political barriers presented by groups who do not want or understand the vaccine—and the dangers of those who distort public health campaigns and target health workers for violence.
8) The global burden of non-communicable diseases
At the 65th annual World Health Assembly in May, the World Health Organization and member states established the first global targets on non-communicable diseases. The goal: to reduce premature mortality from cardiovascular disease, cancer, diabetes, chronic respiratory disease, and other non-communicable diseases by 25% by 2025.
As people around the world work to change their behaviors and lifestyles, health workers in many countries will find they need new training to help them not only educate clients about preventing disease but also to respond to chronic illness and provide long-term care, including end-of-life and palliative care.
9) Safety for health workers during conflicts
Assaults on health facilities, health workers, and the patients they serve are all too common during armed conflicts and civil disturbances. Our own staff members in Mali have seen firsthand how dangerous—even lethal—these attacks can be. Violence can make it impossible for health workers to deliver care and can devastate health systems. It can also cause health workers to flee when their presence is most crucial.
In 2012, IntraHealth teamed up with several partners to launch the Safeguarding Health in Conflict Coalition. The coalition promotes the safety and security of health facilities, health workers, ambulances, and patients during periods of armed conflict or civil violence. And thanks in part to the coalition’s campaigning efforts, the World Health Assembly passed a resolution in May requiring the World Health Organization to lead international data collection of attacks on health workers, facilities, transports, and patients.
Throughout 2013, health workers in Mali, Pakistan, and other countries in conflict will continue their struggle to provide care while also trying to keep themselves and their clients safe.
10) Mobile health and new technologies
It takes imagination, resourcefulness, and problem-solving skills to create technologies that will really work in developing countries. Frontline health workers are in a prime position to inform those innovations—and can expect more of them in 2013.
Take mSakhi, for example. We worked with accredited social health activists (or ASHAs) in India to develop this mobile health application so that crucial information is now available to ASHAs during their home visits with new mothers and babies. Because of the ASHAs’ feedback and enthusiasm, Mashable named mSakhi one of 2012’s five biggest innovations for social good. We hope to make it available to even more ASHAs this year.
Then there’s the Pratt Pouch, which Duke University developed and is testing with health workers in several countries. It’s a ketchup packet-like container that holds a premeasured dose of antiretroviral medication, which can drastically decrease a newborn’s chances of contracting HIV. The World Health Organization named it one of the top 10 innovative health technologies of the year. IntraHealth has partnered with Duke to develop training materials for the pharmacists and other workers who will be charged with filling and heat-sealing the pouches. Health workers around the world may see a new training curriculum for the Pratt Pouch in 2014.
Oleh: Friskila Damaris Silitonga, SKEP, NS, MPH
Oleh: Friskila Damaris Silitonga, SKEP, NS, MPH
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